DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-0476 DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey Form and Instruction
VA Form 10-0476 Michael E. DeBakey Patient Satisfaction Survey DeBakey Survey 10-0476.pdf Facilitated telephonic survey Form and Instruction
VA Form 10-0480 Compensation and Pension Examination Program (CPEP) Vete CPEP Veterans Survey 10-0480.pdf To Be Determined Form
Generic_Submission_M.E.DeBakey Patient Satisfaction.docx Michael E. DeBakey Home Care Program Patient Satisfaction Survey IC Document
Generic_Submission_(CPEP) Veterans Satisfaction Survey.docx Compensation & Pension Examination Program (CPEP) Veterans Survey IC Document

Information Collection (IC) Details

IC Title:	DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-0476	Michael E. DeBakey Patient Satisfaction Survey	DeBakey Survey 10-0476.pdf	Facilitated telephonic survey	No		Paper Only
Form	VA Form 10-0480	Compensation and Pension Examination Program (CPEP) Veterans Satisfaction Survey	CPEP Veterans Survey 10-0480.pdf	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,055	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,714	1,714
Annual IC Time Burden (Hours)	170	170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Michael E. DeBakey Home Care Program Patient Satisfaction Survey	Generic_Submission_M.E.DeBakey Patient Satisfaction.docx	04/11/2013
Compensation & Pension Examination Program (CPEP) Veterans Survey	Generic_Submission_(CPEP) Veterans Satisfaction Survey.docx	04/11/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.